Programa de Pós-Graduação em Ciências do Movimento Humano - PPGCMH/ICS

URI Permanente desta comunidadehttps://repositorio.ufpa.br/handle/2011/15816

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Avaliação da potência vertical de membros inferiores em pessoas com Parkinson
(Universidade Federal do Pará, 2024-12-23) SILVA, Vinicius Baia; MONTEIRO, Elren Passos; http://lattes.cnpq.br/0920248966438368; https://orcid.org/0000-0001-7757-6620
Parkinson's disease (PD) is considered neurodegenerative, polysomatic, and idiopathic, which affects the central nervous system, more precisely the dopaminergic neurons of the basal ganglia. The neural disorders of the disease cause neuromuscular declines, such as a reduction in motoneuron responses, potential action firing, muscle recruitment, power, strength, and muscle mass. Muscle power is fundamental in initiating movements, and its decline implies frailty, risk of falls, greater dependence, and low quality of life. In this context, it is relevant to evaluate muscle power in people with Parkinson's (PwP). However, using high- cost equipment that is difficult to transport and handle presents challenges for carrying out clinical assessments in this population. The evaluation of the vertical power of the lower limbs allows the interpretation of biomechanical mechanisms, such as strength, speed, and power. Clinically, the analysis of these aspects of Parkinson's disease is essential for rehabilitation strategies that emphasize the maintenance and improvement of these components. The literature reports that mobile applications are an alternative to specific instruments (for example, photoelectric cells, and goniometers). However, it is necessary to test the reproducibility and agreement of these instruments in populations with significant motor declines, such as individuals with Parkinson's disease (PD). Objective: To describe the vertical power of PcP through the performance of the vertical countermovement jump (CMJ) and evaluate the agreement in jump performance measurements by different evaluators (intra-evaluators) and between equipment (inter-instruments): a contact for vertical jumps and a My Jump 2® mobile app. Methods: The participants were 19 PwPs over 40 years old (15 men and 4 women), with PD staging between 1 and 3 according to the Hohn & Yearh Scale. The participants underwent clinical assessments: cognitive screening, anamnesis, and disease monitoring. For anthropometric assessments, we used a stadiometer, digital scale, and anthropometric tape measure. To assess performance, we used the CMJ vertical jump test, which was recorded simultaneously using the contact mat for vertical jumps and the My Jump 2® app installed on an IOS version 17.2 smartphone, recording at 240 Hz and 1080 HD. The volunteers were instructed to perform 3 consecutive jumps, with an interval of 120 seconds between each jump. For the statistical analysis, descriptive statistics were used to characterize the sample and then a mixed model was adjusted to assess the difference between the measurements. Next, the Bootstrap technique with 10,000 resamples was applied to calculate the limits of agreement, and histograms were generated to visualize the distribution of the Intraclass Correlation Coefficient (ICC). Finally, Bland-Altman plots were created to visualize the agreement between raters and instruments. All the intra-rater and later inter-instrument analyses were carried out using the R software. Results: As result, the values of ICC= 0.952 between evaluators and ICC= 0.948 between instruments indicate a very strong intra-evaluator and inter-instrument correlation. In both analyses, the limits of the confidence interval were close, with little variation in the estimates and reliability of the ICC. In the Bland-Altman analyses, there was agreement and consistency between assessors and instruments, with biases of 0.36 cm between assessors and -1.3 cm between instruments. Conclusion: Our results suggest that the My Jump 2® app is an alternative tool for assessing lower limb power using the CMJ vertical jump test in people with Parkinson's disease.
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Determinantes de sarcopenia e fragilidade em pessoas com Parkinson no contexto amazônico
(Universidade Federal do Pará, 2025-03-26) SANTOS, Ana Carla de Matos; MONTEIRO, Elren Passos; http://lattes.cnpq.br/0920248966438368; https://orcid.org/0000-0001-7757-6620
Introduction: Aging is a natural process characterized by the progressive loss of tissue and organ function, increasing the predisposition to various diseases, including Parkinson's Disease (PD). Among the conditions associated with PD, sarcopenia and frailty stand out as relevant geriatric syndromes. Sarcopenia is defined by the progressive reduction of muscle mass, strength, and function, while frailty is characterized by greater vulnerability to stressors, impacting physiological reserve and functional capacity. Despite distinct concepts, both share pathophysiological mechanisms affecting muscle power, such as chronic inflammation, oxidative stress, and neuromuscular degeneration. The absence of accessible and standardized instruments for screening these geriatric syndromes in clinical settings represents a challenge, especially considering the applicability of these methods in different sociodemographic contexts, such as in the Amazon region. Objective: This study aimed to analyze the profile of sarcopenia and frailty, as well as possible associations with clinical parameters of PD and sociodemographic aspects in people with Parkinson's disease (PwP) living in the community of a state in the Amazon region. Methods: This is an observational and analytical study, including PwP over 40 years of age, of both sexes. Initially, an anamnesis was conducted to collect sociodemographic data, followed by using instruments such as SARC-Calf and Short Physical Performance Battery (SPPB) for sarcopenia screening, and Fried's Phenotype for frailty screening. Vertical power was analyzed using the My Jump 2 app, considering parameters such as jump height, flight time, take-off velocity, force, and power. For statistical analysis, Spearman's correlation coefficient was used to identify possible associations between sarcopenia and frailty with clinical and sociodemographic variables. Subsequently, logistic regression was conducted to assess whether body mass predicted sarcopenia. Regarding frailty, none of the predictors were significant. All analyses were performed using SPSS software (IBM, Greenville, SC), version 25.0. Results: A total of 24 people with Parkinson's disease (PwP) were evaluated, 83.3% of whom were male, with a mean age of 66.35 years, living with a spouse and children (37.5%). They were stratified into sarcopenic (29.2%) and non- sarcopenic (70.8%) groups. An association was observed between sarcopenia and body mass (OR = 1.438; CI = 1.045 – 1.980). Regarding frailty, the prevalence was lower than reported in the literature, possibly due to the small sample size. Conclusion: This study concluded that body mass was a risk predictor for sarcopenia in PwP, and that the sample profile was predominantly male, with a higher occurrence of falls in stage 2 of PD and a high prevalence of pre-frailty. Despite the absence of other significant predictors for sarcopenia and frailty, the findings highlight the need for clinical standardization and universal diagnostic criteria, considering regional sociodemographic aspects.
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Parkinson pai d’égua: protocolo de danças amazônicas sobre os parâmetros não motores e motores em pessoas com Parkinson
(Universidade Federal do Pará, 2024-06-25) COSTA, Carla Luana Alves; HAAS, Aline Nogueira; http://lattes.cnpq.br/6600425096998622; https://orcid.org/0000-0003-4583-0668; MONTEIRO, Elren Passos; http://lattes.cnpq.br/0920248966438368; https://orcid.org/0000-0001-7757-6620
Introduction: In Parkinson's disease, dopaminergic neurons degenerate. Dance has been shown to be a non-pharmacological intervention for PD symptoms. However, the benefits are mostly assessed in motor symptoms. However, it is believed that the characteristics of Amazonian dances can be a stimulus for improving and/or maintaining the motor and non motor symptoms of PD. However, no studies with Amazonian dances in people with Parkinson's were found Methods: The aim of the study was to analyze the responses of Amazonian dances and cultural manifestations on the non-motor symptoms of global cognition, mood, depressive symptoms and quality of life in people with Parkinson's in the Amazon region and to evaluate an intra-group control period of Health Education and compare it with the effects of dances. This is a longitudinal study. Participants will be people with Parkinson's of both sexes, stage 1 to 4 on the Hoehn and Yahr scale. The volunteers took part in evaluations before and after the Health Education period, Protocol and follow up. The data was collected and tabulated in Excel, and analyzed using SPSS software version 27.0. We used descriptive statistics to characterize the sample, and Generalized Estimating Equations to compare moments, groups and subtypes of PD. In addition, the effect size was calculated using Edges' d. Results When analyzing depressive symptoms, significant differences were found for the Group factor (p=0.049) and the ES intervention (7.00±1.15; 6.50±0.96). When we analyzed mood states by domains, for the Anger domain, the Group (p= 0.35) and Time (p= 0.66) factors did not show significant values. For global cognitive function, significant differences were found for the Group factor (p<0.001).Conclusion: The present study shows benefits of the Health Education Program of the Amazonian Dances and Cultural Manifestations protocol for PcP in non-motor symptoms of depressive symptoms in both interventions. This indicates that Amazonian dances and cultural manifestations can be used with caution for the rehabilitation of non-motor and motor symptoms in people with Parkinson's disease.
Acesso aberto (Open Access)
Respostas de um programa de reabilitação locomotora de caminhada nórdica e livre em variáveis fisiomecânicas da marcha de pessoas com doença de Parkinson: um ensaio clínico randomizado
(Universidade Federal do Pará, 2023-04-27) RODRIGUES, Jacqueline Lima; MONTEIRO, Elren Passos; http://lattes.cnpq.br/0920248966438368; https://orcid.org/0000-0001-7757-6620
Introduction: Muscle performance patterns during gait are altered in people with Parkinson's disease. In addition, the analysis of the pendular mechanism is important because it reflects the reduction of muscular effort required to accelerate and raise the center of mass during walking. This inefficient gait pattern in people with Parkinson's disease (PwP) can result in increased energy expenditure during walking, requiring therapeutic interventions that can reduce these symptoms in order to provide greater mobility and quality of life to this population. Recent findings demonstrate that the pendular mechanism (Recovery) is greater with the use of poles, which allows to indicate the hypothesis that a neurofunctional locomotor Nordic walking (NW) rehabilitation program may induce greater adaptations in the pendular mechanism compared to free walking (FW) in individuals with PwP. Objective: To analyze the responses of a neurofunctional locomotor rehabilitation program with and without poles of NW on physiomechanical parameters of gait in PwP. Materials and Methods: This study was characterized as a longitudinal randomized controlled trial, in which we investigated volunteers who met the following eligibility criteria: clinical diagnosis of idiopathic Parkinson's disease, with staging between 1 to 4 on the Hoehn & Yahr (H&Y) scale, sedentary, over 50 years of age, of both sexes. The volunteers were randomized into two groups: NW (with poles) and FW (without poles), and performed the exercises for nine weeks. The evaluations of the physiomechanical parameters, more specifically, Recovery, Internal mechanical work (Wint), Internal mechanical work of the arm, trunk, and leg (Wint arm, Wint trunk, Wint leg, respectively), External mechanical work (Wext), vertical external work (Wext vertical) and horizontal (Wext horizontal), and Total mechanical work (Wtot) of PwP's gait were analyzed during a treadmill walk at a self-selected speed pre- and post-rehabilitation program. A three- dimensional kinematic analysis was performed, with a video capture system composed of six infrared cameras from the VICON Motion Capture System 3D kinematics (Oxford, United Kingdom), with a camera sampling rate of 100 Hz. Thirty-six reflective markers (Vicon Biomechanics Marker Accessories) in the form of a sphere, with a diameter of 14 mm, were used and located on both sides of the body and in the regions of interest. The collected data were analyzed in NEXUS software, tabulated, and organized into spreadsheets in Excel 2016 software. After these steps, mathematical routines were employed in the Matlab® software for calculating the study outcomes. Generalized Estimating Equations were used to compare between groups (NW and FW) at different time points (pre and post). We used H&Y and Froude number values of volunteers as covariates, so that the values were fixed in the statistical model at the following values: H&Y (1.5) and Froude number (0.07). For the analysis of Group, Time, and Group*Time interactions effects, Bonferroni post-hoc was used to identify differences between means in all variables. The effect size was calculated by Hedge's g, and an α=0.05 was adopted. Results: The final sample consisted of 20 volunteers (NW: n=13 and FW: n=7), with NW group (64.23 ± 10.52 years) and FW group (69.71 ± 6.82 years) mean age, NW group (80.07 ± 14.79 kg) and FW group (80.07 ± 14.79 kg) body mass, NW group (1.68 ± 0.07 m) and FW group (1.68 ± 0.06 m) height. Significant differences were found for the factor Time for the Recovery (p=0.04), Wext (p<0.001), horizontal Wext (p=0.04), and vertical Wext (p<0.001) variables. For the interaction Group*Time, significant differences were found for the Wext (p=0.03) and vertical Wext (p=0.02) variables, whereas for the other variables, the values remained similar or were not modified (p>0.05). Conclusion: We concluded that the Recovery was performed more efficiently after the locomotor rehabilitation intervention for both groups, therefore individuals with Parkinson's disease presented a more optimized pendular mechanism. The Wext of individuals with Parkinson's disease who walked with and without poles reduced after the intervention, but the FW group presented lower Wext, meaning less energy was required to move in the environment in relation to the center of mass. Both NW and FW groups reduced their vertical Wext after the rehabilitation program, but the FW group demonstrated lower post-intervention values, indicating that the volunteers did not show as much efficiency in raising their center of mass. Horizontal Wext increased for both groups after the rehabilitation program, demonstrating that both groups showed improvements in their acceleration with respect to projection forward after the intervention. Our findings indicate that the locomotor rehabilitation model with and without sticks can be used by healthcare professionals to rehabilitate locomotion, making the pendular mechanism more optimized and the gait more efficient for mild to severe PwD. Clinical Trials Registration Number: NCT03355521.

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